The video I have chosen is All Hope is Gone, which Eleanor Kingston narrates. In this video, a daughter narrates her story with a broken heart and comes to terms with the passing of her mother after she had lung cancer. This brief shows that sometimes there are big voids in making decisions and communication protocols in healthcare systems, especially during end-of-life care and treatment options (Ryan et al., 2022). Despite her extensive background as a psychiatric nurse, the patient’s desires and those of her family were overlooked, leading to a profound statement from her on the way home: “All hope is gone.” Therefore, This story can be the representative that we use to look at issues of patient-centered care and argue that a model that includes the inclusion of the patient and family members in the decision-making process should be more encouraged.
The overarching aspect of decision-making I will be looking at is treatment options and end-of-life care planning. This part of the case raises an important point about activities that encourage patients and families to be in the middle of a disease when the patients already feel the unavoidable outcome. It requires healthcare practices to make these patients feel they are being taken seriously and treated with respect and care.
Discourse on EOL care planning reveals an intricate process involving culture, patients and their families, and communication as the critical factor of expertise. As the story in `All Hope is Gone’ implies, it is the complex relationships between the caregivers, the patient as well as her family that the picture shows the lapses found in the decision-making process, not capturing the patient’s and her family’s desire and way of life.
Research indicates that finding a place for individual patient and family choices in care plans would be appropriate. That is why a patient-centered approach, in which shared decision-making is the key, would be better (Engle et al., 2021). For instance, traditional collectivist cultures like Asian societies are likely bound by filial relations and notions of mutual respect, often involving family members or leaders to make joint or delegated decisions deeply rooted in filial piety and loyalty (Li et al., 2021). However, the positive aspects go hand in hand with its negatives, and therefore, sometimes, the patient’s perspective is not wholly addressed, suggesting the need for precision-based dialogue from the very start of hospice (Pun et al., 2023).
Additionally, published papers manifest that even though family caregivers and patients emphasize pain and symptom management, there needs to be more understanding regarding other care preferences issues like the level of information sharing, healthcare engagement, and others (Detering et al., 2010). Such dissimilarities may cause some sort of miscommunication or problems, which means that genial and empathetic communication methods need to be used to make all the people feel on the same page when it comes to the wishes and expectations of everyone ((Detering et al., 2010).
The advent of guidelines and protocols, such as COMFORT (Villagran et al., 2010) and SPIKES (Ciarkowski, 2020), which serve as frameworks for the improvement of EOL communication (Pfeifer and Head, 2018), focusing on individual autonomy rights and also averring the diseases involving both the patient and the family in EOL discussions concerning care and decisions (Ciarkowski, 2020). These strategies are developed to avoid miscommunications and promote whole-minded care that respects the patient’s supercities and wishes while considering the family’s part and views.
Mixing patient and family views into EOL care plans, the decision maker gives proper attention to these views and comforts and generates a better and more professional care path for the patient and his/her family during the most challenging times (National Institute on Aging, 2022).
In ”All Hope is Gone”, Ellie Kingston tells a moving story and shows how the terrible consequences of making important decisions without family involvement can be demonstrated in the case of her mother’s last months of her life. This anecdote manifests that not just caregivers but families matter profoundly, not just playing the role of caregivers but making some critical decisions for the patient, whose observations may be helpful and a significant factor to consider when it comes to care satisfaction. The research has recognized the downsides of the non-involvement of families in illness care. Regarding inclusiveness, the majority would like to have them involved as it is a more comprehensive care that observes the patients’ values and acceptable care (Symmons et al., 2022). In addition, family involvement in the decision-making process has been closely linked with patient and family satisfaction, the patient’s anxiety level, and possibly improved bereavement measures (Pun et al., 2023).
As the gap in the process of conversation represented in the Kingston narrative is in line with this, models like the COMFORT communication model and the SPIKES protocol indicate structured methods for better communication and involvement of family in the decision-making process (Farzad Reisi Mahdiabadi et al., 2023). These models suggest effective communication strategies with clear, concrete messages that can include patients and their relatives in treatment decision-making processes and impact expectations and treatment options. Health system workers pay attention to a platform of healthcare professionals performing family meetings, giving families detailed information based on families’ needs and a former decision-sharing environment. Through the implementation of such models, healthcare practitioners can ensure that the family voice is being heard and duly incorporated during the planning process of the patient’s care (Farzad Reisi Mahdiabadi et al., 2023), thus resulting in care that more closely matches the patient and family wishes and lessens the distress of being powerless and voiceless, as it is captured in the heart-rending description by Kingston.
Disaster narrated “All Hope is Gone,” clearly and shoutingly communicating partitioning between healthcare providers, patient, and her daughter is how lack of conversation leads to unattended demands and culminates in worsened detrimental effects of the disease. This communication gap, where the patient’s and her family’s wishes were overlooked, underscores a prevalent issue in end-of-life care (Anderson et al., 2019): the utmost necessity of effective and considerate communication.
Research provided some time ago emphasizes how effective communication is realized through the COMFORT model, which stresses the clear, kind, and consistent interaction between patients, their families, and medical professionals (Villagran et al., 2010). The SPIKES protocol is also part of the plans. These approaches are all about those patients’ needs, values, and preferences, which keeps the patients feeling heard and like everybody is valued (Ciarkowski, 2020). For instance, proactive communication—beginning discussions about care preferences, treatment options, and so forth early and often—later may have turned full. At the same time, this positively affects her experience by providing a sense of control and user involvement in care planning (Ekberg et al., 2021).
In order to enhance the practical manner of communications, healthcare professionals need to take on a patient- and family-centered approach and encourage as well as facilitate open dialogues about end-of-life care preferences among the patient and the family members (Ekberg et al., 2021). Otherwise, providers may find it challenging to deliver well-mannered, sensitive, and empowering conversations that effectively encourage desired behavior changes. Using communication models such as COMFORT, SPIKES, and others at all levels of care will help medical practitioners advise patients and families in a way that is in line with all the administrative decisions, even though the situation is unpredictable (Pfeifer and Head, 2018).
Provided such provisions, healthcare systems facilitate an ambiance of openness, trust, and respect, which, taking into account, dramatically impacts the patient and family happiness, lowering anxiety levels and, therefore, increasing the quality of end-of-life care.
By involving the patients in end-of-life care, as highlighted in “All Hope is Gone,” one highlights the pivotal need for patient-centered care, making it evident that involving the patients in their end-of-life care choices is highly important and must be taken into consideration (Steel and Owen, 2020). When patients involved are not part of the decision process regarding their care, their unmet needs can lead to suffering. This highlights the significance of giving patients the decisions in their treatment planning (Steel and Owen, 2020).
Research confirmed that advance care planning is one of the most popular tools that puts patients’ wishes at the end of life into practice and increases the level of satisfaction on both patients’ and families’ sides (Brinkman-Stoppelenburg et al., 2014). Engaging patients is achieved by having facilitators take the patients through discussion pathways that revolve around the illness’s goals and wishes, understanding the illness and available treatment options, and involving the families in these conversations (Steel and Owen, 2020). These preserved strategies greatly respect patient autonomy and are enormously beneficial in caregiving for the seriously ill at the end of life.
The evaluation shows that adequate communication, closer family bonds, and fixed assertion of patients’ rights must stand at the core of effective end-of-life care. These factors, among others, are explained to ensure treatment conforms to the patient’s wishes, reduces compulsive suffering, and improves the general quality of care. These experiences have taught me the importance of empathetic communication, understandable to the patient and family, and of the highest ethical standards in practice. I will administer caring and consistently patient-centered end-of-life care in this nursing practice.
Anderson, R. J., Bloch, S., Armstrong, M., Stone, P. C. and Low, J. T. (2019) ‘Communication between healthcare professionals and relatives of patients approaching the end-of-life: A systematic review of qualitative evidence.’ Palliative Medicine, 33(8) pp. 926–941.
Brinkman-Stoppelenburg, A., Rietjens, J. A. and van der Heide, A. (2014). ‘The effects of advance care planning on end-of-life care: A systematic review.’ Palliative Medicine, 28(8) pp. 1000–1025.
Ciarkowski, C. (2020). SPIKES: A Strategy for Delivering Bad News. accelerate.uofuhealth.utah.edu. University of Utah. [Online] https://accelerate.uofuhealth.utah.edu/improvement/spikes-a-strategy-for-delivering-bad-new.
Detering, K. M., Hancock, A. D., Reade, M. C. and Silvester, W. (2010). ‘The impact of advance care planning on end of life care in elderly patients: randomised controlled trial.’ BMJ, 340(mar23 1) pp. c1345–c1345.
Ekberg, S., Parry, R., Land, V., Ekberg, K., Pino, M., Antaki, C., Jenkins, L. and Whittaker, B. (2021). ‘Communicating with patients and families about illness progression and end of life: a review of studies using direct observation of clinical practice.’ BMC Palliative Care, 20(1).
Engle, R. L., Mohr, D. C., Holmes, S. K., Seibert, M. N., Afable, M., Leyson, J. and Meterko, M. (2021). ‘Evidence-based Practice and patient-centered care: Doing Both Well.’ Health care management review. United States, 46(3) pp. 174–184.
Farzad Reisi Mahdiabadi, Samaneh Mirzaei, Entezari, A. and Khadijeh Nasiriani (2023). ‘The effect of implementing the COMFORT communication model on communication skills of nursing students.’ International Journal of Palliative Nursing. Mark Allen Group, 29(9) pp. 412–420.
Li, W. W., Singh, S. and Keerthigha, C. (2021). ‘A Cross-Cultural Study of Filial Piety and Palliative Care Knowledge: Moderating Effect of Culture and Universality of Filial Piety.’ Frontiers in Psychology, 12(12).
National Institute on Aging (2022) Making decisions for someone at the end of life. National Institute on Aging. [Online] https://www.nia.nih.gov/health/end-life/making-decisions-someone-end-life.
Pfeifer, M. and Head, B. A. (2018). ‘Which Critical Communication Skills Are Essential for Interdisciplinary End-of-Life Discussions?’ AMA Journal of Ethics. American Medical Association, 20(8) pp. 724–731.
Pun, J., Chow, J. C. H., Fok, L. and Cheung, K. M. (2023). ‘Role of patients’ family members in end-of-life communication: an integrative review.’ BMJ Open, 13(2) p. e067304.
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